In this post, I excerpt “Practical approach to blunt cerebrovascular injury” from EM Quick Hits 11 Blunt Cerebrovascular Injury, Physostigmine, TEE in Cardiac Arrest, Understanding Nystagmus, Subtle Inferior MI, Choicebo.
Andrew Petrosoniak on a practical approach to blunt cerebrovascular injury (29:43)
Practical approach to blunt cerebrovascular injury
- Think about the possibility of blunt cerebrovascular injury in your head injured patients getting a CT head and/or neck, an often under-recognized phenomenon.
- Non penetrating injury to the carotid or vertebral arteries in trauma can result in aneurysm, dissection (with subsequent ischemic stroke), and even transection.
- The Denver Criteria have 97% sensitivity and 47% specificity for blunt cerebrovascular injury.
- If positive by the Denver criteria, CTA of the head and neck is the imaging modality of choice in the ED.
- Decision making in blunt cerebrovascular injury treatment involves weighing the risk of bleeding (in the trauma patient who may have other injuries) with anti-thrombotic medications, against the risk of stroke without these medications; consultation with neurosurgery/neurology is advised.
Denver screening criteria for blunt cerebrovascular injury
The Denver Screening Criteria are divided into risk factors and signs and symptoms
Signs and Symptoms
- Arterial hemorrhage
- Cervical bruit
- Expanding neck hematoma
- Focal neurologic deficit
- Neuro exam inconsistent with head CT
- Stroke on head CT
- Midface Fractures (Le Fort II or III)
- Basilar Skull Fracture with carotid canal involvement
- Diffuse axonal injury with GCS<6
- Cervical spine fracture
- Hanging with anoxic brain injury
- Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status